Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Patient take-up and adherence to antidepressants and talking therapy is low. However, little is known about how GPs recommend these treatments and whether patients accept them.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To examine how GPs recommend antidepressants and talking therapy, and how patients respond.</jats:p></jats:sec><jats:sec><jats:title>Design &amp; setting</jats:title><jats:p>A total of 52 recorded primary care consultations for depression, anxiety, and stress were analysed.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Using a standardised coding scheme, five ways doctors recommend treatment were coded, conveying varying authority and endorsement. The treatment recommendation types were as follows: more directive pronouncements (I’ll start you on X); proposals (How about we start X?); less directive suggestions (Would you like to try X?); offers (Do you want me to give you X?); and assertions (There are medications that might help). It was also coded whether patients accepted, passively resisted (for example, withholding response), or actively resisted (for example, I’ve tried that before).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 33 recommendations occurred in 23 consultations. In two-thirds of cases, GPs treated the patient as primary decision-maker by using suggestions, offers, or assertions. In one-third of cases, they used more directive pronouncements or proposals. GPs endorsed treatment moderately (67%), weakly (18%), or strongly (15%). Only one-quarter of recommendations were accepted immediately. Patients cited fears about medication side effects and/or dependency, group therapy, and doubts about treatment efficacy. Despite three-quarters of patients resisting, 76% got prescriptions or self-referral information for talking therapy.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Initially, GPs treat patients as the decision-maker. However, although patients resist, most end up with treatment. This may impact negatively on treatment uptake and success. Social prescribing may fill a treatment gap for some patients.</jats:p></jats:sec>